Welcome to Baylor Scott & White Medical Center - Centennial

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Patient Reference Number Please enter the Patient Reference Number

Please enter the Patient Reference Number

Patient’s Date Of Birth A valid date is required

Patient’s Date Of Birth Month , required

Patient’s Date Of Birth Please enter the Patient’s Date Of Birth Please verify the Patient’s Date Of Birth entered is correct. Please enter a valid day of the month. , required Patient’s Date Of Birth Please enter the Patient’s Date Of Birth Please verify the Patient’s Date Of Birth entered is correct. Year must be in format YYYY e.g. 1983 , required

Please enter the Patient’s Date Of Birth

Year must be in format YYYY e.g. 1983

Please enter a valid day of the month.

Please verify the Patient’s Date Of Birth entered is correct.

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Consent to Electronic Communications

By accessing this Site, you consent to receive disclosures from us electronically through Email, Text and/or Phone (including automated dialing and pre-recorded messages) and understand that information sent through these methods may not be encrypted or secure (“Services”). By consenting to the electronic delivery of disclosures, you agree that we may provide electronically any and all communications concerning any payments you make to us or any payment plan agreements you enter into with us now or in the future, including disclosures required by state or federal law (the “Disclosures”). To electronically receive and view and electronically save or print the Disclosures, you must have: a personal computer or device with Internet access; a widely-used, recent-generation web browser; a widely-used, recent-generation portable document file reader; the email address you have provided us (or a new email address you subsequently provide us); and a printer, hard drive or other storage device.

By agreeing to the Services, you promise that you own or customarily use the telephone number and email address you provide. You also promise to notify us by calling 1(800) 346-0775: (1) within 30 days if your email or phone number changes, (2) if you wish to withdraw your consent, or (3) if you wish at any time to receive any information that we have provided electronically in paper form at no cost to you. Any such request will only be effective as to communications we send after 72 hours from the date of your notice. If you withdraw your consent, you may no longer be eligible for certain services we only offer electronically and you will not be able to receive disclosures from us electronically or do business with us electronically.

You understand that we will continue to use the email address and phone number you provided unless you provide notice of a change. Failure to notify us may result in missed or delayed communications or information being transmitted to unintended parties.

I have read the Consent to Electronic Communication and accept all terms.

Consent to Electronic Communications

By agreeing to the Services, you promise that you own or customarily use the telephone number and email address you provide. You also promise to notify us by calling 1(800) 346-0775: (1) within 30 days if your email or phone number changes, (2) if you wish to withdraw your consent, or (3) if you wish at any time to receive any information that we have provided electronically in paper form at no cost to you. Any such request will only be effective as to communications we send after 72 hours from the date of your notice. If you withdraw your consent, you may no longer be eligible for certain services we only offer electronically and you will not be able to receive disclosures from us electronically or do business with us electronically.

You understand that we will continue to use the email address and phone number you provided unless you provide notice of a change. Failure to notify us may result in missed or delayed communications or information being transmitted to unintended parties.

I have read the Consent to Electronic Communication and accept all terms.

Consent to Electronic Communications

I have read the Consent to Electronic Communication and accept all terms.